1541 S. Page Ct.
'BUILDING PERMIT No.' BLD2004-03875
?iJ~;:'~{~~~~~: , '
Q"~'\..~^Nl\iH ElM
'\~\tt~j~~tlf/ '
,
TYPE OF PERMIT '
Tenant Improvement (Extensive) , CITY
DATE: 11/18/2004
JOB ADDRESS: 1541 S PAGE CT
LEGAL DESCRIPTION: N TR 6094 LOT 4
APPLICANT: JOSEPH DAB BY .
OWNER lNFORMATION:
'0 SA Properties
PO Box 49051
Los Angeles. CA '90049
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 51~3
INSPECTION REQUEST LINE;:
(714) 765 - 4626 '
CENSUS CODE: 437
QUARTER SECTION: 117
ARCHITECT/ENGINEER INFORMATION:
YVETTE DABBY
16733 VENTURA BLVD.
~NCINO. CA 91436
PR09ESSED BY:. KBT
CONTRACTOR INFORMATION:
DAVID V KARNEY
.12011 SAN VICENTE BLVD, #606
LOS ANGELES. CA 9Q049:0COO
, BUSINESS PHONE: 310 82',-5637
JOB DESCRIPTION:n for offices,. restrooms,. handicap ramp, and warehouse ::-nprovement
VALUATIOJ\i: 40.000.00 [
L OWNER-BUILO::R'OECLARA TION
I hereby affirm under penalty of perjury that I am exempt frorr. tria Cpntracio(s License Law fur the ,folJow.ing reason (Sec. 7031.5 Business and
Professions Code: any dty or county which req uires '3 permit to construct, a }~~r, improve, demolish or repa ir any structure, prior to its issuance, also
requires the_applicant for such permit to file a signed s~atament that he is' iico,,\:rsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(cornmencing with Section 7000 of Divis,ion 30t the Busi!1ess,ard Profess:~ps Code) cr that he is exempt therefrom al1d.the baSIS _for the all~ed
exemption. Any violation of Section 7031.5 by anyapplicar.t for a permit s'uL{ects the appllcantto a civil penalty o.f not more than five hundred-dollars
,($500): A'" ,
o I, as owner of property, or m'y employees with wages ~~s their sul<;- CQmr.@lsation,will do the work, and the structure is not jntende~ or offered for
o. sale (Sec~ 7044 Business and Professions Code: The Contractor's License ;j~VI does. not apply to an owner of property who builds or irilp~OVflS
thereon, and who does such work himself or he rsf?-I f or through his or r.~:- ov~j"/f:rnpICYEles, provided that'such I r1:1pl":lvements are not intended or
. offeree for sale. If, however, ~he buik!!rlg or improvl.!ment i3 s0id with one Yf,k Gf oompietLon, the owner-builder,will have the burden of proving that he
did not build or improve for the purpose of sale). ' .,:.,.", ,
'0', I; 3s'the ownercfthe property. 3m exdusiv::-ly ;,":onhacting with :jcGn::;erii~?ntracters'to construct tti_e~roject (See. 7044 Business and Professiolls
Cede: .The,C.ontractor's License Law doe::; not apply te. an owner ('f pr()per!:~;;W'ho builds'or illlproves th,erecn, and whocor.tracts for-such.projects~"{ith
p-~ol'tractor(s) IiGensed pursuant to the Contractor's liCense L:1W). ,i . -
LJI.'olll eJ(~mptunder Sec. " B & P.C. forth:s rd85'jJ1: _,_ J__
Oat,s-: Owner:
c= WORKER'S COMPENSATION DECLARATION JL_.___---.J
I hereby, affirm under penalty of perjury one of. the following dec~arations: i:
o I have and will maintain a certificate of'consent to self-insure for wo(ker~ compensation,
3S pr~vjded for by Section 3700 of the Labor Code, fo~ the perfcr(ljanb~.of trf~ wor't.. for whictl
~)i'~ permit is issued.' -. . k;, .
- ,111(.>veand will f'!1alntain' w, orker'scompef!satio~ insurance, o.s' :eq':-i,imd tJ,':,' Section 3700 of
eLabor Code, fo.r the performance of the work fer which tilis ;:::errnit IS i;:;s,;!:<:i. My worker's
. Compensation insurance carrier and policy are: j': .
Carrier: STATE FUND INS. - . , Policy Number: ~614e.s:..:::;)1 .
This seetion need not be completed if the pennit .is for one hundred ~ollars {$1{i~j or_lESS.
0'1 certify that in the performance of the work for whicll this per~it..is rszu?d,"~~~ha 11 not
QmpJoy-any person in any'manner so as to become subjzct t.:l the 'Ncrl<13rs c}:~pensatjon laws
of Califomia, and agree that if I should become subject to the \'Iorker~s corr.p;';n's~t:on
provisions of Section 3700 of the Labor Code' all rorthwilll compJy-w:th ~r'~':'se provisions.
,'-"",
Date: 11/18/2004 Applicant: !
WARNING: FAILURE TO SECUR VEP;<G,E IS
UNLAWFUL, AND SHALL SUBJE T AN EMPLOYER TO CRIMIf\J~~, P~:f\l~~t.n~Sp.;ND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($1QO.000).IN ADUTlON TO THE
COST OF COMPENSATION. DAMAGES AS PROV:DED FOR IN SECTIO~j 3706 OF THE
LABOR CODE. INTEREST AND ATTORNEY'S FEES.'.
! CONSTRUCTION LENDING AGENCY ....
I h0reby affirm under penaity of.per},~iY that ~h~re'is a ~o~str~?:~?~) ~~nd:f1g,;~~,;ncyfor ti-;e
.~,~. ~ 0_ :;. "'-". .,.;, -:!i'f--::-:-Z'-"."t-,;;:,~.'f-::.': '.V~~;:~~~t:>?-=-;";~,-:o--,.;'i; ~-~:"'&i..i {:.:..::,~,:;:.~;--,-::::;.;",:.;:;;j-.-- _,r_,,-
Lender's Information: ' .
I certify that I have read this application and state that the above informatiOn IS correct. 'I
lagree to comply with all city ordinances and state laws relating to building construction,and
here y authorize representives of-this city to enter upon the above mentione::i property for
sp ttion purpq , III ./ ''''1 .
, I 11 bate:11/18/2004
Sign re of Applicant or gent , .
The permit sh expire by limitation nd become null and void if the building or
work has not passed final inspection 365 days from the datI' of permit issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION ~
I hereby affirrriund~r penalty of perjury that I s;m
licensed under provisions of .:::ha'pter 9 (commencin~J
with Sldction?OOO) o~, _ i,VS,ion 3 of the B~lsiness and
professio~c e. ',' 'I ' .
11118'2004 I
Date: 'Contractor
NUMBER
146202
TYPE
TYPE
Construcion Types:
III N. .
Occupancy Groups:
B. . . .
Fire Sprinkle,'ed?
T.1. Area:
EXPIRATION DATE
6/30/2005
B
HIe
Y.ES
2.118
'V
".-, ":~ >.
Fees paid for Permit:
Total:
1.291.99
INSPECTION RECORD
INSPECTION . . . DATE INSPECTOR
.
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter .
SelbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following appiicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) .
Mechanical (GroundWork)
Electrical (Underground Conduit) .
Pre-slab (CompactiohlMembrane.Rei nt.
Underpinning (Floor Job.t/Glrders)
Do not cover or conceal the work below. until the . 0
following 'applicable items have been signed: .
1st Floor Shear . .'
Firesprinkler. (Rough) '.
2nd Floor Shear .
Roof (She;lthlnglDlaphragm'Frame)
Masonry (ReinfJBond BeainJPre-Grout)
Rough. Plumbing. (Top Out)
R.ough Mechanical
Rough E1ectrical(ury ....."1 . .
Rough Electrical .
Framing (Only after Plbg.. Elec.. Mech. and Fire) Z-3-oU. '" r ... L
Insill;ltion (SoundlEnergy) 1.-1,. o'/- i;j.~ ..1
Do not tape or plaster until the fOllowing applicable
items have been signed: . ~
Drywall 17.-(.,-"rr J. '11 01),
Penetr;ltions (Fire R;lted) Electrical ~
Penetrations (Fire R;lted) Mechanical
.Penetr;ltlons (Fire Rated) Plumbing ..
Interior lath .
Exterior lath
GENERAL ITEMS
Exterior Plaster (BraNn Coat) ,
T .Bar Electrical . . II<M .pi( ~
T-Bar Mechanical 1/.{}.r.{)~ . .'-' ~.
T -Bar Structural '. I/-/Z'()S
Sewer
Water Engineering Backflow . .
Water Service .
.FINAL INSPECTIONS
Electrical Final .
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519 ~
Zoning 765-5139
Building Final (Last InSpection- Only . I tJ J>!'
. After Above Complete) '1'V)
PARTIAL INSPECTIONS
Buildina Insoections .' .
~1o~4 ~'r:;~~~
/ /h :~2 IYt, 4.1-' .. .
Inspector
Mechanicallnsoections
Plumbina Insoections.'
Electricallnsoections